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By Jane Lowers

In Dr. Robert Novelline's mind, a thoracic CT study is not unlike a painting by one of the great masters.

As a young art student, he learned to absorb the details of complicated works: What time of day does the painting depict? From what direction is the wind blowing? How many people are in the scene? These are details a casual observer might overlook at first glance, but they are essential to understanding a work in its entirety. In that regard, sorting out the nuances of art appreciation and reading clinical images have much in common.

It's not a surprising parallel coming from Novelline, who spent his teen years studying painting at the School of the Museum of Fine Arts in Boston but went on to author the textbook that introduces most medical students to the world of radiology.

Just as art appreciation skills can be applied to history, literature, and other fields, a solid understanding of medical imaging improves medical students' understanding of other specialties, said the Boston-area native who earned his medical degree at Boston University, did his residency at Massachusetts General Hospital, and has been on the faculty at MGH ever since. Indeed, advances in technology are making radiology increasingly central to medical education.

Novelline may be best known for the Squire's Fundamentals of Radiology textbooks that introduce medical students to the various methods of imaging the human body and its many structures. It is most medical students' first formal foray into radiology as a field, and for some, the only one they will have, as rotations in radiology remain optional at some medical schools. He also coauthored Living Anatomy: A Working Atlas Using Computed Tomography, Magnetic Resonance & Angiography Images, which correlates anatomy to its radiological presentation.

Students at Harvard Medical School are required to take a radiology clerkship, a crucial juncture for both the student and the specialty, according to Novelline. The exposure to the ways disease manifests itself on an image and is subsequently treated helps them make sense of other specialties. It's also an essential time for radiology as a field to make a good impression. Although a radiology clerkship is usually done in the third or fourth year, students who take it early in the third year report that it helps them in future clinical rotations.

"Students make decisions about what they want to study when they see who teaches the courses and who seems to enjoy their work," he said. "Students choose radiology as a specialty not just for economic reasons but because of the experience they had looking at how radiologists feel about their jobs."

Novelline is pleased to see that medical students around the country are sharing his enthusiasm for the field.

"There are about 900 residency positions available in radiology yearly," he said. "Last year there were 1500 applicants. The quality of applicants has increased tremendously in the past five to seven years. We're getting the best of each medical school."

One of the factors at work may be the increasing number of medical schools that require radiology education. Novelline has been called in as a consultant by nearly every medical school in the country that has made radiology training mandatory for medical students. It's a crucial step in bolstering radiology's future, he said, and one that needs to start with radiology department chairs.

"Some chairs put more emphasis on residents and fellows, but medical students are where it starts," he said.

In developing his education materials, Novelline relies on 25 years of experience teaching the radiology clerkship at Massachusetts General Hospital. He took over the course from his mentor, radiology educator Dr. Lucy Frank Squire, whom he credits with showing him the importance of making education engaging and accessible. His courses focus on small-group interaction and problem solving rather than lectures, and students tend to respond well.

"She taught me to put the students to work with problems and puzzles to solve, so that they would be completely engaged rather than passively listening," he said. "She also taught me to write for students in a clear, simple, and entertaining fashion."

Interactive learning provides other dividends for students. Under Novelline's tutelage, all students who do the MGH clerkship are required to prepare their final paper using electronic media to create a Power Point presentation. For many, it is their first experience with the technology that has become ubiquitous in reporting scientific research at meetings.

Novelline gives credit for his work in education to a supportive, innovative environment at MGH, where he serves as director of an emergency radiology department that sees 80,000 cases per year. He publishes extensively on multidetector CT for trauma and nontrauma applications, including appendicitis, and on teaching and learning technologies for radiology, including the influence of PACS on medical students' education. In addition to teaching, researching, and reading film, he founded the Alliance of Medical Student Radiology Educators and is active in the RSNA, American Roentgen Ray Society, and American Society of Emergency Radiology.

"Dr. Novelline is the leading emergency radiologist in the world. It is very unusual for someone to have achieved leadership in both teaching and a subspecialty area," said Dr. James Thrall, chair of radiology at MGH.

Novelline's next mission is to further integrate radiology training with other medical specialties, using technology to make students' training more comprehensive and standardized. This is an undertaking of "The Academy," a group of 100 senior educators at Harvard Medical School working to revolutionize medical education.

Medical students today are faced with growing volume but shorter patient stays. Patients with interesting diseases don't necessarily remain in the hospital long enough for students to gain the familiarity they need to treat the same condition when they enter practice. On a neurology rotation, for example, a student might see only half of the classic presentations.

Enter radiology. Using MR and CT images, students can gain familiarity with the diseases they don't see in their rotations and come away with a more complete understanding of the field.

"In the past, we've relied on teaching by coincidence," Novelline said. "Now, we can remove the gaps in content and teach consistently."